title: Redevelopment of tertiary psychiatric services in British Columbia: a prospective study of clinical, social, and residential outcomes of former long-stay inpatients.
abstract: OBJECTIVE
  The objective of this study is to assess the clinical and social outcomes for a cohort of patients who were part of the redevelopment of psychiatric services in British Columbia.
  
  
  METHODS
  This study used a naturalistic, quasi-experimental design, to examine the outcomes of a cohort of 189 long-stay patients at Riverview Hospital (RVH), some of whom moved into Tertiary Psychiatric Residential Facilities (TPRFs), some into the community in less structured facilities, and some remained at RVH. Data was collected from clinical files at RVH and at each participating site, semi-structured interviews and self-report measures were completed with patients. In addition, semi-structured interviews were also conducted with staff members.
  
  
  RESULTS
  There was very minimal evidence of transinstitutionalization to prisons or homelessness; one participant resided in a correctional facility, one resided in a forensic facility, and one participant spent some time homeless. In addition, the majority of participants remained in residences that provided 24h care. Eighty percent of our population was diagnosed with a schizophrenia spectrum disorder. Psychiatric symptoms remained fairly stable; some embarrassing social behaviors increased; however, aggressive behaviors showed no increase; neuropsychological deficits did not deteriorate, there were even some improvements. Participants demonstrated increases in several independent living skills including: money management, food preparation and storage, job skills, and transportation skills. In addition, participants experienced a significant increase in their perceived quality of life.
  
  
  CONCLUSIONS
  This study builds on existing research demonstrating that well-planned and appropriately resourced hospital closures can lead to positive psycho-social outcomes for participants and can successfully avoid negative outcomes such as transinstitutionalization to the judiciary system and homelessness.
authors.affiliation: British Columbia Mental Health & Addiction Services, Canada. kpetersen2@forensic.bc.ca
authors.forename: Karen L
authors.initials: KL
authors.lastname: Petersen
authors.forename: Tonia L
authors.initials: TL
authors.lastname: Nicholls
authors.forename: David
authors.initials: D
authors.lastname: Groden
authors.forename: Norbert
authors.initials: N
authors.lastname: Schmitz
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Stip
authors.forename: Elliot M
authors.initials: EM
authors.lastname: Goldner
authors.forename: Leslie M
authors.initials: LM
authors.lastname: Arnold
authors.forename: Alain
authors.initials: A
authors.lastname: Lesage
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001955:British Columbia; D005260:Female; D006778:Hospitals, Psychiatric; D006801:Humans; D007297:Inpatients; D008137:Longitudinal Studies; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology* / Q000523:psychology* / Q000628:therapy*; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D012919:Social Behavior; D013997:Time Factors; D055815:Young Adult
keywords: Community-based care; Deinstitutionalization; Homelessness; Mental illness; Psychiatric; Transinstitutionalization